Research Consent Form Template

If you are conducting interviews, making observations, or hosting focus groups as part of a research study or communications strategy, you must obtain written consent from people whose words you’d like to publish. Even if you create a fake name or pseudonym for the person you are quoting, you still need their permission to do so. This is an important part of ethical, human-based research.

We created the following Research Consent Form template to help you obtain permission from people you interview and want to quote:



Research Consent Form


Dear Participant:

We are asking you for permission to use your interview as part of [Insert Name of Study or Communication Effort here].  If you give us permission, we might quote you in [Insert publication types or venues here].  Of course, it is also quite possible that we will not use your work, even if you give us permission to do so.  If you are willing to allow us to reproduce your words, please fill out the appropriate items on the bottom of this sheet and return it to us.

Thank you for your consideration and help,

[Insert Names of Writers/Researchers Here]



To:  [Insert Names of Writers/Researchers Here]

You have my permission to use my interview in professional publications and conference presentations.

Please check one of the following:

_____ You may use my first and last name to identify my work.

_____  You may use my first name only.

_____  You may use my words, but not my name.  (If you check this option, we will either use your work without any name or we will make up a name.)

In addition, please check below if you wish identifiable features to be changed:

_____  You may use my words, but please change any identifiable details, such as names of people, locations, or institutions.

Signature of Interviewee:_______________________

Printed Name of Interviewee:____________________



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